81504 Medicaid reimbursement rates by state
Clinical lab tests. 15 state Medicaid programs publish a fee-for-service rate for 81504 at the independent level. Rates run from $16.22 in Pennsylvania to $520.00 in Montana, with a median of $468.00.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 15
- Median rate
- $468.00units vary by state
- Highest
- $520.00Montana
- Medicare (non-facility)
- —not on the physician fee schedule
81504 rate in every state
One like-for-like fee-for-service rate per state, highest first. Units can differ between states; the per-hour column converts time-based units.
| State | Medicaid rate | Unit | Per hour | Managed-care plans | % of Medicare | Source |
|---|---|---|---|---|---|---|
| MontanaIndependent (non-agency) provider · Montana Medicaid and HMK Plus (fee-for-service) | $520.00since 2018-07-01 | — | — | Not classified | — | Montana Healthcare Programs fee schedule |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $520.00since 2018-04-15 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $520.00since 2020-01-01 | — | — | Plans negotiate; applies out of network | — | KY Medicaid Clinical Lab fee schedule (2 |
| New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division) | $520.00since 2024-11-01 | — | — | Plans must pay at least this | — | New Mexico Medicaid Fee for Service CPT |
| HawaiiAny qualified provider (rate does not vary by provider) · Hawaii Medicaid (Med-QUEST) fee-for-service | $520.00since 2026-06-01 | — | — | Plans negotiate; applies out of network | — | Medicaid Fee-For-Service (FFS) Fee Sched |
| South DakotaAny qualified provider (rate does not vary by provider) · South Dakota Medicaid (fee-for-service, DSS Division of Medical Services) | $520.00since 2019-12-01 | — | — | Not classified | — | South Dakota Medicaid Laboratory fee sch |
| MissouriAny qualified provider (rate does not vary by provider) · Missouri MO HealthNet (fee-for-service) | $468.00since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | MO HealthNet fee schedule: Independent L |
| MississippiAny qualified provider (rate does not vary by provider) · Mississippi Medicaid (fee-for-service) | $468.00since 2022-07-01 | — | — | Plans must pay at least this | — | DOM Comprehensive Fee Schedule, May 2023 |
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $458.58since 2024-09-01 | — | — | Plans negotiate; applies out of network | — | Rates for Clinical Laboratory Services ( |
| New HampshireAny qualified provider (rate does not vary by provider) · New Hampshire Medicaid (fee-for-service, DHHS / NH MMIS) | $449.80since 2025-01-01 | — | — | Plans negotiate; applies out of network | — | 2026 Fee Schedule - Covered Procedures R |
| IdahoAny qualified provider (rate does not vary by provider) · Idaho Medicaid (fee-for-service, Division of Medicaid / Gainwell) | $449.28since 2025-09-01 | — | — | Not classified | — | Idaho Medicaid Numerical Fee Schedule Ju |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $416.00since 2025-01-01 | — | — | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service) | $405.60since 2024-07-01 | — | — | Not classified | — | SCDHHS Independent Lab and Radiology Fee |
| FloridaAny qualified provider (rate does not vary by provider) · Florida Medicaid (fee-for-service) | $280.80since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | Independent Laboratory Fee Schedule (202 |
| PennsylvaniaAny qualified provider (rate does not vary by provider) · Pennsylvania Medical Assistance (fee-for-service) | $16.22since 2015-09-01 | — | — | Plans negotiate; applies out of network | — | PA DHS PROMISe Outpatient Fee Schedule ( |
Rates are per the unit shown for each state; units can differ between states. Medicare amounts are computed from the CMS relative value file and locality cost indices with the CMS formula; states with several Medicare localities show a range. Confirm rates with the payer before billing.
Frequently asked questions
What does Medicaid pay for 81504?
It depends on the state. Of the 15 states with a published fee-for-service rate, the median is $468.00. Montana pays the most ($520.00) and Pennsylvania the least ($16.22).
Which state pays the highest Medicaid rate for 81504?
Montana, at $520.00, effective 2018-07-01.
Do managed-care plans pay the same rate for 81504?
Not necessarily. Each state's plan contracts decide whether plans must pay at least the fee-for-service rate, pay a state-set rate, or negotiate their own. The table shows the rule for each state, cited to the contract or statute.